Symposia
Addictive Behaviors
Alexis Kuerbis, Ph.D., LCSW (she/her/hers)
Hunter College, City University of New York
Astoria, New York
Jon Morgenstern, PhD (he/him/his)
Professor, Psychiatry
Zucker School of Medicine at Hofstra/Northwell
Glen Oaks, New York
Background: Stepped care comprises interventions in which the type and/or dosage of treatment offered is tailored to a patient’s baseline clinical presentation, then adjusted over time in response to patient progress. There are no empirically supported stepped care intervention algorithms for individuals with alcohol use disorder (AUD), and no study has explored stepped care offered via telehealth or in-person (participant’s choice). Furthermore, while studies of stepped care have focused on age-defined samples (i.e., college students, older adults), age group comparisons of such interventions are rare. This study, implemented pre-COVID, explored the moderating impact of modality and age group on treatment to reduce drinking.
Method: A sequential multiple assignment randomized trial design was implemented with 160 individuals with AUD with a goal to reduce or abstain from drinking. Participants elected whether they received in-person or telehealth interventions. All participants received brief advice (BA). Three weeks later, they were re-assessed; those who did not reduce drinking to low-risk guidelines (non-responders) were randomized to two sessions of motivational interviewing (MI) or more BA. Participants were then reassessed at week 8. Non-responders were re-randomized to receive either MI alone or MI plus behavioral self-control therapy (BSCT) and evaluated at week 13. Age group and modality were input as separate moderators of treatment for sum of standard drinks (SSD) and heavy drinking days (HDD).
Results: 66% of participants elected telehealth. There was no main effect of modality on drinking outcomes. Main effects of age group demonstrated that middle-aged (48-56) participants reduced their drinking most compared to the younger (22-47) and older adults (57-73) (p < .01). Overall, participants who received any BSCT had the greatest drink reduction (by 3 drinks, p=.03). Participants who received MI at week 4 and BSCT at week 8 outperformed all other groups on both outcomes. Neither modality nor age group moderated the treatment effect.
Conclusion: Modality did not impact the quality or effect of the interventions. MI + BSCT, which provided more sessions over a longer period provided optimal outcomes. More research is needed to determine whether such an algorithm holds across heterogenous groups of individuals with AUD, such as across age group.